Purpose
This study aimed to evaluate the radiological and functional results of secondary
thumb reconstruction via ectopic banking of bony phalanges from a nonreplantable amputated
thumb.
Methods
Thumb reconstruction was performed using the bony phalanges from a nonreplantable
amputated thumb that were ectopically banked in a subcutaneous pocket. A wraparound
flap was harvested from the ipsilateral great toe and wrapped around the bone graft.
After surgery, the results were assessed in terms of infection, range of motion, bone
union of the graft, and signs of osseous resorption of the reconstructed thumb.
Results
Fifteen patients underwent secondary thumb reconstruction using this technique between
January 2003 and October 2018. Ten patients were followed up for at least 6 months
(6 months to 9 years) and were included in this study. All wraparound flap transfers
were viable. No bone graft infection was observed. In the 6 cases in whom the interphalangeal
joint was not fused, the interphalangeal joint motion ranged from 5° to 60° with an
average of 35.0° ± 15.1°. The metacarpophalangeal joint motion ranged from 5° to 66°,
with an average range of motion of 48.2° ± 23.6° for the cases in whom the joint was
not fused. In 8 of the 10 patients, the time of bone ectopic banking was within 10
days. In these patients, bone union with no osseous atrophy was observed. In 2 patients
whose phalanx was banked for more than a month, different degrees of bone resorption
of the grafted phalanx were evident after transplantation, although no further treatment
was required.
Conclusions
Bony phalanges from a nonreplantable amputated thumb can be ectopically banked and
used for secondary reconstruction of the thumb. The duration of banking before thumb
reconstruction should be no more than 2 weeks.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: August 26, 2022
Accepted:
June 29,
2022
Received:
October 25,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
